Organization
PROVIDENCE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MCKISSICK NP (NURSE PRACTITIONER)
(803) 240-2847
Entity
Organization
Contact information
Practice address
424 LEWIS HARGETT CIR STE 250, LEXINGTON, KY 40503-3687
(803) 240-2847
Mailing address
1301 SUMMERVILLE AVE, COLUMBIA, SC 29201-1927
(803) 240-2847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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